Carotid endarterectomy prior to major abdominal aortic surgery.

BACKGROUND

Major aortic surgery carries a high risk of stroke. Carotid artery occlusive disease (CAOD) has been identified as one of the contributing risk factors. Regarding the long-term prevention of stroke, carotid endartectomy (CEA) seems to be superior to the best medical treatment in patients with high-grade CAOD. However, the role of CEA prior to major aortic surgery has not been studied.

DESIGN

Prospective study, observational design.

SUBJECTS AND

SETTING

201 patients referred to a community hospital for major aortic surgery.

INTERVENTION: The patients were non-invasively screened by continuous-wave and duplex Doppler ultrasonography for the presence of CAOD. In 41 patients with angiographically confirmed high-grade CAOD, CEA was performed prior to major aortic surgery.

MAIN OUTCOME MEASURE: Combined mortality and major morbidity from CEA and abdominal aortic surgery.

RESULTS

There was no mortality or morbidity related to CEA. Total perioperative mortality related to major aortic reconstruction was 3.5%. No new perioperative focal neurologic deficits occurred except for one fatal stroke in a patient in whom CEA had been judged not to be indicated.

CONCLUSIONS

CEA can be performed safely prior to major aortic surgery resulting in excellent overall neurologic outcome in patients with high-grade CAOD. We propose that patients scheduled for major aortic surgery be screened for the presence of high-grade CAOD and that CEA be performed first, if indicated according to published guidelines.